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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802463
Report Date: 07/29/2021
Date Signed: 04/26/2022 01:20:23 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/27/2021 and conducted by Evaluator Angel Ascencio
COMPLAINT CONTROL NUMBER: 29-AS-20210727164650
FACILITY NAME:PEOPLE'S CARE HOWEFACILITY NUMBER:
565802463
ADMINISTRATOR:POURI, KIRSTENFACILITY TYPE:
735
ADDRESS:3851 HOWE RDTELEPHONE:
(805) 398-5096
CITY:FILLMORESTATE: CAZIP CODE:
93015
CAPACITY:6CENSUS: 5DATE:
07/29/2021
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Kirsten PouriTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Facility minimum staffing requirements are not met
INVESTIGATION FINDINGS:
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On 7/29/2021 at 12:45 PM, Licensing Program Analyst (LPA) Angel Ascencio along with Tri-County Quality Assurance(QA) Specialist Liz Aced-Arnett conducted an unannounced complaint investigation for the allegation listed above. LPA met with Belen Gutierrez, House Lead. Administrator Kirsten Pouri arrived at 3:00 PM, and met with LPA. At 3:20 PM, LPA toured the facility indoor and outdoor. Entrance interview conducted. On 04/22/2022, this report was amended to add additional information, which does not change the original findings of the substantiated report being issued referenced on 07/29/21.

It is being alleged that the facility minimum staffing requirements are not met. On 7/29/2021, between 12:53 p.m. and 3:15 p.m., LPA Ascencio along with QA Aced-Arnett conducted staff interviews. Interviews with 7 out of 8 staff members revealed that there are days that they are short-staffed with one (1) or two (2) staff present at times throughout the day or different days. LPA received and reviewed staff schedules for the weeks of 7/18-24/2021 and 7/25-31/2021.
Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 29-AS-20210727164650
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: PEOPLE'S CARE HOWE
FACILITY NUMBER: 565802463
VISIT DATE: 07/29/2021
NARRATIVE
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Upon review of the staff schedule for the week of 7/25/2021, the schedule states that there should be four (4) staff members present on 7/29/21. LPA observed a total of three (3) staff members present at the time of visit at 12:45 p.m., two (2) in the permanent side and one (1) in the crisis side. Interview with staff #1 (S1) revealed that there was a one (1) hour and a half gap on the morning of 7/29/21, and that they only had 2 staff members present. LPA reviewed the day schedule for 7/29/21 and observed that there were three (3) staff members scheduled to come in at 6:00 a.m. and another staff member at 7:30 a.m. LPA received the Employee Pay Summary Report, which identifies the start and end times of a staff members’ shift for the entire month of July 2021. Upon further review of the Employee Pay Summary Report, it was revealed that on 7/3/2021 during the entire night shift (10:00 p.m. – 6:00 a.m.), there were only two (2) staff members present. On 7/5/2021 during the morning shift (6:00 a.m.- 2:00 p.m.) there was one (1) staff member present starting at 6:00 a.m. with the second staff member arriving to the facility at 7:20 a.m. and a third staff member arriving at 9:50 a.m. On 7/25/2021 there were two (2) staff present starting at 6:00 a.m. with a third staff member arriving at 7:20 a.m. Later that evening, there were two (2) staff members present during the night shift (10:00 p.m. – 6:00 a.m.) On 7/26/2021 there were two (2) staff members present during the morning shift (6:00 a.m. – 2:00 p.m.) with a third staff member arriving at 1:40 p.m. Later that evening, there were two (2) staff members present, as well as on 7/28/202, there were also only two (2) staff members present during the night shift. LPA interviewed QA Aced-Arnett starting at approximately 3:15 p.m. on 7/29/2021, who confirmed that the minimum staff present at all times should be no less than four (4); three (3) staff on the permanent side and one (1) staff on the crisis side of the facility. It was also revealed there is no limit to the amount of hours staff are allowed to work in regards to funding from Tri-Counties Regional Center (TCRC), as long as the minimum staffing ratio is met at all times. On 7/29/2021, LPA reviewed residents’ Individual Program Plans (IPPs). Upon review of the IPPs, it was revealed that client#1 (C1) requires 1:1 staffing. C2’s IPP, dated 1/29/2020, was also reviewed and stated C2 is “attached to a 1:1 support and requires line of sight supervision at all times.” Additional information was obtained from People’s Care District Manager via email dated 9/13/2021, stating the facility, at any point in time, should have four (4) staff in place per shift.

Based on observation, review of files, and interviews, the department has sufficient evidence to determine that the allegation of facility minimum staffing requirements are not being met. Therefore, the above allegation is SUBSTANTIATED at this time.


The following deficiencies were observed (See LIC 9099-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties.Exit interview conducted. A copy of the report and appeal rights were provided via email.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20210727164650
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: PEOPLE'S CARE HOWE
FACILITY NUMBER: 565802463
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/29/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/13/2021
Section Cited
CCR
85065.5(a)(1)
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85065.5 Day Staff-Client Ratio(a)(1) For Regional Center clients, staffing shall be maintained as specified by the Regional Center but no less than one direct care staff to three such clients.
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Admin stated that they will hire more for the missing schedule. Ensure that shifts are covered when people are calling out. Admin stated they will revise the schedule, keep it up to date and submit a revise schedule to LPA email.
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Based on LPA's observations, the administrator did not comply with the section cited above as 7 out of 8 staff members mentioned that the facility is short staff and need more help which poses a potential health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
LIC9099 (FAS) - (06/04)
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